Code of Practice for Residential Care Homes for Persons with

Code of Practice for Residential Care Homes for Persons with
Code of Practice
for
Residential Care Homes for
Persons with Disabilities
(March 2002)
Table of Content
1.
Introduction
1.1 General
1.2 Purpose of the Code of Practice
1.3 Entry to Premises
1.4 Certificate of Registration
1.5 Insurance Coverage
2.
Classification of Residential Care Homes for Persons with Disabilities
2.1 Classification of Homes
2.2 Meaning of the different classes of Homes
2.3 Relationship of Disability Types and Level of Care Required
2.4 Mapping of Existing Services with the 4 Levels of Care
3.
Management
3.1 Display of Name of Residential Care Home for Persons with Disabilities
3.2 Procedures on Admission of Residents
3.3 Schedule of Daily Activities
3.4 Staff Duty List
3.5 Record Keeping
3.6 Staff Meeting
4.
Building and Accommodation
4.1 General
4.2 Lease Conditions and Deed of Mutual Covenant
4.3 Restriction on Home Premises
4.4 Design
4.5 Basic Facilities
4.6 Accessibility
4.7 Fire Exits
4.8 Heating, Lighting and Ventilation
4.9 Water Supply and Ablutions
4.10 Repair
5.
Safety and Fire Precautions
5.1 General
5.2 Location
5.3 Height
5.4 Fire Service Installations
5.5 Additional Requirements
5.6 Fire Precautions
5.7 Fire Resisting Construction
6.
Floor Space
6.1 Area of Floor Space
6.2 Number of Residents
7.
Staffing
7.1 Employment of Staff
7.2 Duties and responsibilities
7.3 Overnight Staff
7.4 Conditions of Service
7.5 First Aid Training
7.6 Relief Staff
7.7 Importation of Labour
8.
Furniture and Equipment
8.1 General
8.2 Dormitory
8.3 Sitting/ Dining Room
8.4 Toilet/ Bathroom
8.5 Kitchen/ Pantry
8.6 Laundry
8.7 Office
8.8 Medical Equipment and Supplies
8.9 Miscellaneous
9.
Health and Care Services
9.1 General
9.2 Health
9.3 Personal Care
9.4 General Principles in Application of Physical Restraint
9.5 Principles to be Observed in Applying Physical Restraint
9.6 Notes to be Observed in Using Clinical, Para-medical Equipment
10. Nutrition and Diet
10.1 General
10.2 Design of Menu
10.3 Meals and Choice of Food
10.4Preparation and Serving of Food
10.5 Meal Time
10.6 Special Attention on Food Provision
10.7 Provision of Water
10.8 Other Information
11. Cleanliness and Sanitation
11.1 General
11.2 Staff
11.3 Residents
11.4 Cleaning Schedule
11.5 General Sanitation
11.6 Other Information
12. Social Care
12.1 General
12.2 Homely Atmosphere and Adjustment to Home Life
12.3 Social Interaction
12.4 Programmes and Activities
12.5 Contact with Outside World
Appendix
Specimen of Medical Examination Form
CHAPTER 1
INTRODUCTION
1.1
General
1.1.1
This Code of Practice is issued by the Director of Social Welfare, setting out
principles, procedures, guidelines and standards for the operation, keeping,
management or other control of residential care homes for persons with
disabilities. A ‘residential care home for persons with disabilities’ (RCHD)
means any premises at which more than 8 persons with disabilities over the
age of 15 are habitually received for the purpose of care while resident
therein.
1.1.2 This Code of Practice shall not apply to (a)
any residential care home maintained and controlled by the
Government;
(b)
any residential care home used or intended for use solely for the
purpose of the medical treatment of persons requiring medical
treatment;
(c)
any residential care home or type or description of residential care
home excluded by the Director of Social Welfare by order published
in the Gazette.
1.1.3 Operators of residential care homes for persons with disabilities other than
those specified under Para. 1.1.2 above should study this Code of Practice
carefully.
Operators of private residential care homes for persons with
disabilities are advised to notify the Social Welfare Department prior to
commencement of their business in order that due assistance and guidance
are rendered to them by the officers of the Department on implementation of
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the Code of Practice.
1.1.4 Compliance with this Code does not release the operator or any other person
from any liability, obligation or requirement imposed under any other
Ordinance or common law.
1.1.5
With reference to the Disability Discrimination Ordinance Cap. 487, disability
is defined as follows “disability”, in relation to a person, means (a) total or partial loss of the person’s bodily or mental functions;
(b) total or partial loss of a part of the person’s body;
(c) the presence in the body of organisms causing disease or illness;
(d) the presence in the body of organisms capable of causing disease or
illness;
(e) the malfunction, malformation or disfigurement of a part of the person’s
body;
(f)
a disorder or malfunction that results in the person learning differently
from a person without the disorder or malfunction; or
(g) a disorder, illness or disease that affects a person’s thought processes,
perception of reality, emotions or judgment or that results in disturbed
behaviour.
1.2
Purpose of the Code of Practice
This Code of Practice sets out the minimum standards and guidelines for hygiene,
fire, building safety, and the level of care required, which aims at ensuring that
residents in these homes receive services of acceptable standards that are of benefit
to them physically, emotionally and socially.
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1.3
Entry to Premises
It is desirable for operators to allow representatives of the Social Welfare
Department to enter their premises where residential care homes for persons with
disabilities are run, so that the latter could render assistance, where necessary, in
the operation of their homes.
1.4
Certificate of Registration
The operator of a private residential care home for persons with disabilities is
required to register the home with the Inland Revenue Department according to the
Business Registration Ordinance, Cap. 310 and with the Registrar of Companies
under the Companies Ordinance, Cap. 32 if the home is owned by a corporate body.
1.5
Insurance Coverage
According to the Employees’ Compensation Ordinance, Cap. 282, the operator of a
residential care home for persons with disabilities, being an employer, is required to
take out employees’ compensation insurance against his/ her liability to all
employees.
He/ she is also required to comply with the requirements of the
Mandatory Provident Fund Schemes Ordinance. Besides, it is also desirable for
the operator of a residential care home for persons with disabilities to provide other
insurance coverage, e.g. public liabilities, for the home.
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CHAPTER 2
CLASSIFICATION OF RESIDENTIAL CARE HOMES FOR PERSONS WITH
DISABILITIES
2.1
Classification of Homes
Residential facilities are provided for persons with disabilities who, for personal,
social, health or other reasons, cannot live alone or with their families.
According to
the level of care and assistance required by the residents, a residential care home for
persons with disabilities can be classified as (a)
care-and-attention home for persons with severe/ multiple disabilities,
care-and-attention home for the aged blind, and long-stay-care home for
persons with chronic mental illness;
(b)
home/ hostel for persons with severe mental/ physical disabilities;
(c)
home/ hostel for persons with moderate disabilities, home for the aged blind,
and halfway house for ex-mentally ill persons; and
(d)
2.2
supported hostel for semi-independent living.
Meaning of the different classes of Homes
(a)
A ‘care-and-attention home’ means -
an establishment providing residential care, supervision and guidance for persons who
have attained the age of 15 years and who are generally weak in health and are
suffering from a functional (physical and/ or mental) disability to the extent that they
require intensive personal care, attention and assistance in the course of daily living
activities such as dressing, toileting and meals but do not require a substantial or high
degree of professional medical or nursing care.
(b)
A ‘home/ hostel for persons with severe mental/ physical disabilities’ means -
an establishment providing residential care, supervision and guidance for persons who
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have attained the age of 15 years and who are suffering from a functional (physical
and/ or mental) disability to the extent that they lack basic self-care skills and require
assistance in personal and/ or nursing care.
(c)
A ‘home/ hostel for persons with moderate disabilities’ means -
an establishment providing residential care, supervision and guidance for persons
suffering from a functional (physical and/ or mental) disability who have attained the
age of 15 years and who are capable of basic self-care but require supervision and
assistance in activities of daily living.
(d)
A ‘hostel for semi-independent living’ means -
an establishment providing residential care, supervision and guidance for persons
suffering from a functional (physical and/ or mental) disability who have attained the
age of 15 years and who are capable of basic self-care and living semi-independently
with a fair amount of assistance from hostel staff in daily activities.
2.2.1
Classification of Mixed Homes
2.2.1.1 Some residential care homes for persons with disabilities provide
accommodation and care for residents requiring different levels of care and
assistance.
In the case of ‘homes/ hostels for persons with moderate
disabilities’, some may admit residents who require more intensive health
and personal care while some may admit residents with semi-independent
living ability.
2.2.1.2 In classifying a mixed home, i.e. a home that provides places for residents
requiring different levels of care and assistance, the “majority rule” will
apply.
For example, a home with over 50% of its residents being in need of
care-and-attention care is classified as a care-and-attention home.
In cases
where a variety of disabled persons are served, the simple majority rule will
apply i.e. the home will be classified as the one with the largest number of
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residents in that category, but hostel places for semi-independent living will
be disregarded.
A home that serves residents requiring different levels of
care will be classified as either a care-and-attention home, a home/ hostel for
persons with severe mental/ physical disabilities or a home/ hostel for
persons with moderate disabilities, irrespective of the number of hostel
places for semi-independent living.
In case of equal distribution of places
in the various categories, the home will be classified as the one that requires
a higher level of care.
This is to ensure that the well being of the residents
are protected.
2.2.1.3 A change in the proportion of different types of residents will result in the
change of classification of the home according to the above criteria.
2.3
Relationship of Disability Types and Level of Care Required
The following table shows the relationship between different disability types and the
level of care and assistance required -
Disability Type
Intensive
Mental/ Physical Severely MH
Level of care and assistance required
High
Medium
Low
Severely MH
Moderate grade
Moderate/ mild
Handicap (MH/
and/ or PH or
and/ or PH
MH or mild grade grade MH, PH,
PH)/ Blind
aged blind with
requiring
MH with other
blind etc. capable
frail health
assistance in
disabilities, aged
of semi-
requiring nursing nursing and
blind etc. requiring independent living
and intensive
supervision and
with a fair amount
personal
assistance in
of assistance from
care-and-attentio
activities of daily
hostel staff in
n but not
living
daily activities
personal care
necessarily
hospital care
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Disability Type
Level of care and assistance required
High
Medium
Low
Ex-MI requiring a Ex-MI capable of
Mental Illness
Intensive
Chronic MI
(MI)
patients requiring
transitional period semi-independent
intensive personal
of residential care, living with a fair
care and
training and
amount of
supervision but
supervision in
assistance from
not necessarily
activities of daily
hostel staff in
hospital care
living, regular
daily activities
medical follow-up
and medication
etc.
2.4
Mapping of Existing Services with the 4 Levels of Care
The following table shows the mapping of existing government-run or subvented
services with the above 4 levels of care -
Disability Type
Mental/ Physical •
Handicap (MH/
PH)
Level of care and assistance required
Intensive
High
Medium
Care &
• Home/ hostel
• Home/ hostel •
Attention
for the Severely
for the
Home for the
Mentally
Moderately
Severely
Handicapped
Mentally
Disabled
(HSMH)
Handicapped
(C&A/SD)
(HMMH)
• Home/ hostel
for the Severely
Physically
Handicapped
(HSPH and
HSPH/MH)
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Low
Supported
Hostel
Disability Type
Blind/ Visually
Impaired
•
Mental Illness
(MI)
•
Level of care and assistance required
Intensive
High
Medium
Care &
• Home for the •
Attention
Aged Blind
Home for the
(H/AB)
Aged Blind
(Note)
(C&A/AB)
(Note)
•
Long Stay
Care Home
(Note)
Halfway
House
(HWH)
•
Low
Supported
Hostel
Supported
Hostel
Note: C&A Homes for the Aged Blind/ Homes for the Aged Blind as well as Long Stay Care Homes for
Persons with Chronic Mental Illness are licensed under the Residential Care Homes (Elderly Persons)
Ordinance. In the absence of legislative control for RCHDs, these homes will continue to follow the licensing
requirement under the Residential Care Homes (Elderly Persons) Ordinance. Their status will be reviewed at a
later stage.
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CHAPTER 3
MANAGEMENT
3.1
Display of Name of Residential Care Home for Persons with Disabilities
At or near the entrance to the premises of every residential care home for persons
with disabilities, there should be prominently displayed a board or other forms of
signage bearing in conspicuous lettering the name of the home.
3.2
Procedures on Admission of Residents
3.2.1
The rules and regulations of the residential care home for persons with
disabilities should be posted up in the home’s office and printed on the
admission form.
3.2.2
As an admission procedure, rules and regulations, including home charges,
should be explained clearly by the home manager to the disabled person and
his/ her family members/ relatives. Fees that are non-refundable and fees
that can be refundable to residents have to be stated clearly.
3.2.3
Consent should be sought from the resident and/ or his/ her relatives/
guardians in relation to any application of physical restraints either on
admission or as it becomes necessary.
3.2.4
Every applicant should have a medical examination conducted by a registered
medical practitioner before or soon after admission.
The medical
examination primarily serves the purpose of formulating individual care plan
rather than screening. Flexibility should be applied whenever necessary.
Normally, medical history and physical examination with blood pressure
measurement would be sufficient to serve the purpose of formulating the
individual care plan. Unless it is the medical practitioner’s advice that the
applicant has infectious disease and is not suitable for group living, such
pre-admission medical examination may serve as a baseline health information
record and should not be used as a tool to preclude the disabled person from
being admitted. Specimen of medical examination form is at Appendix.
Health records of each resident should be maintained and updated at all times.
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3.3
Schedule of Daily Activities
A routine programme schedule or timetable for daily activities of the residents should
be designed and posted at the office of the residential care home for persons with
disabilities.
3.4
Staff Duty List
A comprehensive duty list for different posts of staff should be drawn up and a staff
duty roster be set for the staff to comply with.
3.5
Record Keeping
3.5.1
3.5.2
The operator of a residential care home for persons with disabilities has to
establish and maintain a record of staff employed in the home with the
following details (i)
name (Chinese and English where applicable), sex, date of birth/ age,
address, telephone number and Hong Kong Identity Card number;
(ii)
supporting documents of relevant qualifications;
(iii)
post to be held in the home;
(iv)
monthly salary;
(v)
working hours and shift of duty;
(vi)
terms of appointment; and
(vii)
date of appointment and resignation or dismissal.
In addition, the operator should also keep particulars of the employees
regarding wages and employment record as legally required under Section
49A of the Employment Ordinance (Cap. 57).
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3.5.3
The home manager of a residential care home for persons with disabilities
should establish and maintain a comprehensive system of records. Such
records should include (a)
Record of Residents
(i)
the name (Chinese and English where applicable), sex, date of
birth/ age and Hong Kong Identity Card number of each
resident;
(ii)
the name, address, telephone number and Hong Kong Identity
Card number of at least one relative or one contact person of
every resident, if available, for future identification;
(iii)
where or how any such relative or contact person may be
contacted in an emergency;
(iv)
the date of admission and discharge of every resident;
(v)
any accident or illness suffered by a resident and of any action
taken in that respect [for details of the health record of the
residents, please refer to paragraphs 9.2(a) and (h)];
(vi)
any death of a resident;
(vii)
any action taken by home staff, including the use of force or
physical restraint, to prevent or restrain a resident from injuring
himself/ herself or others, or damaging property, or creating a
disturbance; and
(viii) possessions or property stored or held on behalf of every
resident by the home, including Hong Kong Identity Card and
medical follow-up card.
(b)
Log Book
A logbook should be used by staff on duty to record daily events
including irregularities observed in and between individual residents
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(including the residents’ physical, emotional or health condition),
follow-up action on any accident, etc. The record should be properly
signed by the staff concerned, be submitted to the home manager or
senior staff for monitoring, and be kept in the home for inspection
purpose.
(c)
Record on Application of Physical Restraint
A separate record should be maintained to record the following
information in respect of the application of physical restraint to a
resident (i)
name of the resident restrained;
(ii)
reason of application;
(iii)
besides consent of the resident and/ or his/ her next-of-kin/
guardians, written medical opinion and written professional
advice of clinical psychologists, if available, should also be
obtained and be reviewed yearly;
(iv)
written consent of the operator/ the home manager;
(v)
written consent of the resident and/ or his/ her next-of-kin or
guardian should be obtained and be reviewed yearly;
explanation to both the resident and next-of-kin/ guardian, if
any, by the home staff should be made and documented;
(vi)
means of physical restraint;
(vii)
duration of application and period of release each time;
(viii) observation on the condition of resident after application; and
(ix)
date and details of periodic evaluation on the need for
continuing the application.
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Record on each application of physical restraint to be kept on the
logbook is also required. Information should include -
(d)
(i)
name of resident restrained;
(ii)
type of restraint;
(iii)
time/ period for application and release; and
(iv)
signature of responsible staff.
Record of Accident
Record of accident is to be kept.
Information should include date
and time of accident, details of accident, resident(s) affected, whether
family members or relatives or contact persons of the resident(s) were
informed and any remedial action taken. The staff who handled the
accident should sign on the record.
(e)
Record of Complaint
Record on complaint or opinion and information made or provided by
resident(s) or any other person relating to the management or operation
of the residential care home for persons with disabilities and any
remedial action taken in that regard should be kept.
(f)
Record of Social Activities and Programmes
Record of social activities and programmes organized for residents is
to be kept. Information should include date, time, type of activities,
number of residents who participated, agency or group which
organizes the activities and response of the residents.
(g)
Other Records
Correspondence with government departments and/ or other agencies
in connection with the operation of the residential care home for
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persons with disabilities should be kept properly for easy reference and
follow-up action. The home should also keep other records as
specified by the Director of Social Welfare.
3.6
Staff Meeting
Staff meeting, briefing session, case conference or discussion among staff should be
conducted by the operator or home manager at regular intervals with record.
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CHAPTER 4
BUILDING AND ACCOMMODATION
4.1
General
All residential care homes for persons with disabilities are subject to inspection by
the Buildings Department (BD) and should comply with the relevant provisions of
the Buildings Ordinance, Cap. 123 and its subsidiary Regulations as well as any
requirement made by the BD regarding building safety.
4.2
Lease Conditions and Deed of Mutual Covenant
It is the responsibility of the operator to ensure that his/ her premises for the
operation of the residential care home for persons with disabilities comply with the
lease conditions and the Deed of Mutual Covenant. Operators should understand
that the lease and the Deed of Mutual Covenant are legal binding documents and
their residential care homes may be ordered to terminate operating in the premises
in civil proceedings.
4.3
Restriction on Home Premises
4.3.1 No part of a residential care home for persons with disabilities shall be
located in or under any structures built without the approval and consent of
the Building Authority, unless exempted by the concerned authority.
4.3.2 A residential care home for persons with disabilities shall not be situated in a
non-domestic building or in the non-domestic part of a composite building if
objection in writing is raised by the Buildings Department to the change in
use.
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4.4
Design
Every residential care home for persons with disabilities should, to the satisfaction
of the Director of Social Welfare, be designed in the following manner to suit the
particular needs of residents (a)
every passage and doorway should be wide enough to accommodate residents
using walking aids or wheelchairs;
(b)
non-slip tiles should be fitted in every place, especially toilets and bathrooms,
where the safety of residents is in jeopardy by reason of a risk of slippage;
(c)
the ceiling of every room should be situated at a height not less than 2.5 m
measuring vertically from the floor or not less than 2.3 m measuring
vertically from the floor to the underside of any beam, unless permitted by
the Director of Social Welfare.
In addition to the above requirements, the operator should ensure that (d)
at least 1 call bell should be installed in each dormitory for care-and-attention
residents;
(e)
all bathrooms, toilets and corridors should be fitted with railings;
(f)
the design of furniture and fitting-out works of the premises should be
hazard-free;
(g)
at all windows, balconies, verandahs, staircases, landings or where there is a
difference in adjacent levels greater than 600 mm, protective barriers designed
to minimize the risk of persons or objects falling should be provided at a
height of not less than 1.1 m and so constructed as to inhibit the passage of
articles more than 100 mm in their smallest dimension; and
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(h)
all design requirements for residential facilities for persons with disabilities
should comply with the Design Manual for Barrier Free Access issued by the
Buildings Department in 1997.
4.5
Basic Facilities
The basic facilities in a residential care home for persons with disabilities should
include dormitories, dining/ sitting area, toilet/ bath/ shower, kitchen, laundry and
office area. All circulation area including corridor and sitting out area should not
be converted into dormitories. A residential care home should provide or make
appropriate arrangements for meals and laundry service for the residents.
4.6
Accessibility
Every residential care home for persons with disabilities should, to the satisfaction
of the Director of Social Welfare, be accessible by emergency services, such as fire
engines and ambulances.
4.7 Fire Exits
4.7.1 Adequate fire exits and exit routes should be provided in every residential
care home for persons with disabilities in accordance with the “Code of
Practice for the Provision of Means of Escape in Case of Fire 1996” issued
by the Buildings Department and any subsequent amendments or revisions
made.
4.7.2 The capacity of a residential care home for persons with disabilities and the
establishment of staff should be taken into account when assessing the
requirements for means of escape.
4.7.3 All doors to protected lobbies, exit doors and kitchen doors should be
capable of self-closing and be kept closed at all times.
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4.7.4 Every exit route should be adequately lit and kept clear of obstructions. A
fire escape route plan should be displayed. The general requirements of
exit routes in the “Code of Practice for the Provision of Means of Escape in
Case of Fire 1996” and any other subsequent amendments/ revisions made
shall be observed and complied with.
4.8 Heating, Lighting and Ventilation
4.8.1 Every residential care home for persons with disabilities should, to the
satisfaction of the Director of Social Welfare, be well heated, lighted and
ventilated.
4.8.2 Every room used for habitation or for the purposes of an office or as a
kitchen in a residential care home for persons with disabilities shall be
provided with natural lighting and ventilation complying with Regulations 30,
31, 32 and 33 of the Building (Planning) Regulations, Cap. 123, sub. leg. F.
Exemption from natural lighting and ventilation may be given by the
Director of Social Welfare on condition that artificial lighting and mechanical
ventilation are provided.
4.8.3 Every room containing a soil fitment or waste fitment in a residential care
home for persons with disabilities shall be provided with a window in
accordance with Regulation 36 of the Building (Planning) Regulations, Cap.
123, sub. leg. F.
Exemption from natural lighting and ventilation may be
given by the Director of Social Welfare on condition that artificial lighting
and mechanical ventilation are provided.
4.9
Water Supply and Ablutions
Every residential care home for persons with disabilities should, to the satisfaction
of the Director of Social Welfare, be provided with 18
(a)
an adequate and wholesome supply of water;
(b)
adequate washing and laundering facilities; and
(c)
adequate bathing facilities.
Details of the facilities required are described in Chapter 8 of this Code of Practice
for reference.
4.10
Repair
Every residential care home for persons with disabilities should, to the satisfaction
of the Director of Social Welfare, be kept in a state of good repair.
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CHAPTER 5
SAFETY AND FIRE PRECAUTIONS
5.1
General
Residential care homes for persons with disabilities are subject to the inspection by
the Fire Services Department (FSD) and operators should comply with any
recommendations made by the FSD regarding safety and fire precautionary measures.
5.2
Location
No residential care home for persons with disabilities should be situated in any part
of (a)
an industrial building; or
(b)
any premises the floor of which is immediately over the ceiling or
immediately below the floor slab of any (i)
godown;
(ii) cinema;
(iii) theatre; or
(iv)
premises wherein any trade, which, in the opinion of the Director of
Social Welfare, may pose a risk to the life or safety of the residents, is
carried on.
Advice from the Fire Services Department should be sought in case of doubt.
5.3
Height
5.3.1 No part of a residential care home for persons with disabilities should be
situated at a height more than 24 m above the ground floor, measuring
vertically from the ground of the building to the floor of the premises in
which the residential care home is to be situated.
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5.3.2 The Director of Social Welfare may by notice in writing served on an
operator authorize that any part of such residential care home for persons
with disabilities may be situated at a height more than 24 m above the
ground floor as may be indicated in the notice.
5.4
Fire Service Installations
Every residential care home for persons with disabilities should, to the satisfaction of
the Director of Fire Services, be provided with adequate fire service installations and
equipment required as a safeguard against fire.
All requirements on fire service installations and equipment are based on the “Codes
of Practice for Minimum Fire Service Installations and Equipment and Inspection,
Testing and Maintenance of Installations and Equipment 1998” issued by the Director
of Fire Services.
The Director of Fire Services in consultation with the Director of
Social Welfare may however, accept variation of any of the following requirements
having regard to the circumstances of any particular residential care home for persons
with disabilities 5.4.1 Requirements for residential care homes for persons with disabilities of less
than 230 m2 in area on any floor -
(a)
A fire detection system should be provided for the entire home and
smoke detector(s) should be provided in area(s) used for sleeping
accommodation. The alarm of such system should be transmitted to the
Fire Services Communication Centre by direct telephone line. The
installation work should be carried out by a Registered Fire Service
Installations Contractor in Class 1.
(b)
A manual fire alarm system should be provided with one actuating point
and one audio warning device located at or near the main entrance lobby
and at a conspicuous location of the common corridor. The alarm of
such system should be integrated with the fire detection system.
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The
design of the manual fire alarm should make reference to paragraph 5.3.1
of the “Design Manual for Barrier Free Access”.
(c)
All fire service installations control panels should either be installed at
the reception area or near the main entrance inside the home or at a
location as approved by the Director of Fire Services.
(d)
One 4.5 kg CO2 gas fire extinguisher should be provided in each kitchen/
pantry/ switch room and one 1.44 m2 fire blanket should be provided in
the kitchen. One 9 litres CO2/ water fire extinguisher should be
provided at the location near the reception area or near the main entrance
inside the home.
(e)
All exits to the exit routes of the building should be indicated by
illuminated exit signs bearing the word “EXIT” and characters “出 口”
in block letters of not less than 125 mm high with 15 mm wide strokes.
Colour contrast for translucent surrounds to lettering should comply with
one of the following and should be consistent throughout the entire home.
Letter Colour
Contrasting Colour
Green
White
(f)
White
Green
If an exit sign is not clearly visible from any location in the home
especially the corridors leading from each room to the exit routes of the
home, suitable directional signs conforming to Table 10 of British
Standard 5499: Part I should be provided at conspicuous locations to
assist occupants to identify the exits in the event of an emergency.
(g)
Emergency lighting should be provided throughout the entire home.
A
self-contained battery type emergency lighting system in accordance with
Part V, Para. 5.9 of the “Codes of Practice for Minimum Fire Service
Installations and Equipment and Inspection, Testing and Maintenance of
Installations and Equipment 1998” will be accepted if the illumination
level of not less than 2 lux for a duration of 2 hours in the event of power
failure is provided.
22
(h)
When a ventilation/ air conditioning control system is provided, it should
be actuated by smoke detectors with a central, manually operated back-up
facility to stop mechanically induced air movement within a designated
fire compartment.
(i)
Primary and secondary electrical supply should be provided to all fire
service installations.
5.4.2 Requirements for residential care homes for persons with disabilities
exceeding 230 m2 or more in area on any floor (a)
A smoke detection system should be provided in area(s) used for sleeping
accommodation. The alarm of such system should be transmitted to the
Fire Services Communication Centre by direct telephone line. The
installation work should be carried out by a Registered Fire Service
Installation Contractor in Class 1.
(b)
A hose reel system should be provided for the home such that every part
of the home premises can be reached by a length of not more than 30 m
of hose reel tubing. Where the building in which the home is located is
not provided with any fire hydrant/ hose reel tank, the hose reel system
may be fed by an improvised water tank of not less than 1500 litres.
The system should have a fixed fire pump which should be permanently
primed and be capable of producing a jet at the hose reel nozzle for a
length of not less than 6 m, at a flow of not less than 24 litres/ minute.
(c)
An automatic sprinkler system should be installed for the entire home
premises. Where the provision of sprinkler water tank is not possible,
the water supply for such system may be permitted to be obtained from
the building’s fire hydrant/ hose reel tank or via direct connection from
town mains. The improvised sprinkler system should be installed in
accordance with the Fire Services Department Circular Letter No. 4/96.
The installation works should be carried out by a Registered Fire Service
Installations Contractor in Class 2.
(d)
A manual fire alarm system should be provided with one actuating point
and one audio warning device at each hose reel point. This actuating
point should include facilities for fire pump start and audio warning
23
device initiation. The alarm of such system should be integrated with
the fire detection system. The design of the manual fire alarm should
make reference to paragraph 5.3.1 of the “Design Manual for Barrier Free
Access”.
(e)
All fire service installations control panels should either be installed at
the reception area or near the main entrance inside the home or at a
location as approved by the Director of Fire Services.
(f)
One 4.5 kg CO2 gas fire extinguisher should be provided in each kitchen/
pantry/ switch room and one 1.44 m2 fire blanket should be provided in
the kitchen.
(g)
All exits to the exit routes of the building should be indicated by
illuminated exit signs bearing the word “EXIT” and characters “出 口”
in block letters of not less than 125 mm high with 15 mm wide strokes.
Colour contrast for translucent surrounds to lettering should comply with
one of the following and should be consistent throughout the entire home.
Letter Colour
Contrasting Colour
Green
White
(h)
White
Green
If an exit sign is not clearly visible from any location in the home
especially the corridors leading from each room to the exit routes of the
home, suitable directional signs conforming to Table 10 of British
Standard 5499: Part I should be provided at conspicuous locations to
assist occupants to identify the exits in the event of an emergency.
(i)
Emergency lighting should be provided throughout the entire home. A
self-contained battery type emergency lighting system in accordance with
Part V, Para. 5.9 of the “Code of Practice for Minimum Fire Service
Installations and Equipment and Inspection, Testing and Maintenance of
Installations and Equipment 1998” will be accepted if the illumination
level of not less than 2 lux for a duration of 2 hours in the event of power
failure is provided.
24
(j)
When a ventilation/ air conditioning control system is provided, it should
be actuated by smoke detectors with a central, manually operated back-up
facility to stop mechanically induced air movement within a designated
fire compartment.
(k)
5.5
Primary and secondary electrical supply should be provided to all fire
service installations.
Additional Requirements
5.5.1
All linings for acoustic, thermal insulation or decorative purposes within
protected means of escape, in ducting and concealed locations in the
residential care home for persons with disabilities should be of Class 1 or 2
Rate of Surface Spread of Flame as per British Standard 476: Part 7 or its
international equivalent, or be brought up to that standard by use of an
approved fire retardant product. The work should be conducted by a
Registered Class 2 Fire Service Installations Contractor.
5.5.2
All ventilating systems that embody the use of ducting or trunking, passing
through any wall, floor or ceiling from one compartment to another, should
comply with the Building (Ventilating System) Regulations, Cap. 123 sub. leg.
J. Detailed drawings showing layout of the ventilating system should be
submitted to the Ventilation Division of the Fire Services Department for
approval. The system should subsequently be inspected by a Registered
Ventilation Contractor at intervals not exceeding 12 months.
5.5.3
All fire service installations and equipment installed in the home premises
should be maintained in efficient working order at all times and inspected by a
Registered Fire Service Installations Contractor at least once in every 12
months.
5.5.4
All fixed electrical installations in the home premises shall be installed,
inspected, tested and certificated by an electrical worker and contractor
registered with the Director of Electrical & Mechanical Services. The
certificate, as proof of compliance with the provisions in the Electricity
Ordinance, Cap. 406, shall be re-validated every five years thereafter.
5.5.5
No storage of dangerous goods in excess of exempted quantity within the
25
meaning of the Dangerous Goods Ordinance, Cap. 295 is permitted without a
licence or approval granted by the Director of Fire Services.
5.5.6
All gas installation work at the home premises must be undertaken by a
Registered Gas Contractor in accordance with the Gas Safety Ordinance,
Cap. 51. Certification of compliance/ completion in accordance with gas
safety regulations and relevant Towngas or LPG codes of practice shall be
provided by the contractor for any new gas installation, or alteration to
existing installations. If a piped gas supply, Towngas or LPG central supply
is already available in the building then it should be used to supply all gas
equipment. Only where a piped-gas supply is not available should
consideration be given to using individual LPG cylinders stored in a
purposely-designed chamber (in accordance with the latest edition of “Gas
Utilisation Code of Practice 06 - LPG Installations for Catering Purposes in
Commercial Premises” issued by the Gas Authority). All gas appliances
installed in residential units should be those models equipped with flame
failure device and only water heaters of the room-sealed type should be
installed. All gas equipment should be inspected/ maintained annually for
safe operation by a Registered Gas Contractor.
5.5.7
An evacuation plan should be drawn up in consultation with FSD. Fire drills
should be conducted at intervals of not less than once every six months.
5.5.8 If PU foam filled mattresses and upholstered furniture are used in the premises,
they should meet the flammability standards as specified in British Standard
BS 7177:1996 and BS 7176:1995 for use in medium hazard premises/ building
or standards acceptable to the Director of Fire Services.
5.6
Fire Precautions
5.6.1
All staff of the residential care home for persons with disabilities must be fully
conversant with the potential fire hazard and any member discovering a fire
must (a)
give an alarm to warn all other staff and residents;
(b)
ensure that the fire is reported to the FSD by telephoning 999; and
26
(c)
5.6.2
make joint effort with other members of staff to evacuate the residents,
particularly those requiring assistance.
Late patrol of the home premises should be conducted every night to ensure
that (a)
all cooking/ heating appliances are turned off;
(b)
all doors leading to common corridors are closed;
(c)
no matter or thing is left to obstruct the exit routes; and
(d)
any door along escape routes, which is required to be locked, should be
openable in the direction of egress without the use of key in an
emergency.
5.6.3
No cooking in naked flame should be permitted in the home premises other
than in the kitchen.
5.6.4
The users’ instructions provided by the manufacturers should be followed
when using gas appliances so as to ensure safe operation including gas
ignition, etc.
5.6.5
Liaison with the Registered Gas Contractor should be made for regular
checking of gas appliances as prescribed in paragraph 5.5.6 above and for
safety advice on gas-related matters.
5.6.6
Smoking should not be permitted in the dormitories.
5.6.7
If gas leakage is suspected, responsible staff must extinguish naked flames
turn off gas taps
not operate electrical switches
open windows and doors wide
Immediately call the gas supplier’s emergency number using a telephone
remote from the affected area.
27
The gas supply must not be turned on again
until it has been checked by the gas supplier’s staff or registered gas
contractor.
IF THE GAS CONTINUES TO LEAK AFTER THE TAPS HAVE BEEN
TURNED OFF OR THE SMELL OF GAS STILL PERSISTS,
RESPONSIBLE STAFF MUST Immediately call emergency services on 999 and the gas supplier using an
outside telephone. Evacuate residents from the area to a safe location and
await arrival of personnel of emergency services.
5.7
Fire Resisting Construction
5.7.1 A residential care home for persons with disabilities should be separated
from other parts of the building in which it is situated and every part in the
home premises should be separated from each other by fire resisting
construction in accordance with the “Code of Practice for Fire Resisting
Construction 1996” issued by the Buildings Department and any subsequent
amendment or revision made.
5.7.2
The kitchen in a residential care home for persons with disabilities should be
separated from other parts of the home premises by walls having a fire
resisting period of not less than 1 hour and the door of the kitchen should have
a fire resisting period of not less than 1/2 hour and be self-closing.
28
CHAPTER 6
FLOOR SPACE
6.1
Area of Floor Space
The minimum area of floor space for each resident is set out as follows MINIMUM AREA OF FLOOR SPACE FOR EACH RESIDENT
Type of residential care home
Minimum area per resident
8 m2
(a) Care-and-attention homes for severely
disabled persons, homes for severely
physically/ mentally handicapped and
multiply handicapped persons
6.5 m2
(b) Hostels for the mildly to moderately
mentally/ physically handicapped
persons, ex-mental patients, and persons
suffering from visual impairment
6.2
Number of Residents
The right number of residents to be accommodated in a residential care home for
persons with disabilities is determined by its physical size and the space standard per
capita area as stated above. Area means the net floor area for the exclusive use of
the home. In determining the area of floor space per resident, the area of staff
dormitory, open space, podium, garden, flat roof, bay window, staircase, column,
staircase hall, lift, lift landing, any space occupied by machinery for any lift,
air-conditioning system or similar service provided for the building, and any other
area in the home which the Director of Social Welfare considers unsuitable for the
purpose of a residential care home for persons with disabilities should be
disregarded.
29
CHAPTER 7
STAFFING
7.1
Employment of Staff
7.1.1
RCHDs should at all times comply with the relevant ordinances for the
promotion of equal opportunities, including the Disability Discrimination
Ordinance, the Sex Discrimination Ordinance and the Family Status
Discrimination Ordinance, and any codes issued under these ordinances.
7.1.2
RCHDs should provide suitable training to front-line staff to raise awareness
of the principles and guidelines relating to equal opportunities and the
provision of assistance to residents with disabilities.
7.1.3
The minimum staffing requirements of each type of residential care home for
persons with disabilities should be as follows Type of Residential Care Home for Persons with Disabilities
Type of
Staff
Home
manager
Care and
Attention
Home for the
Severely
Disabled
(Note)
1 home
manager
Ancillary 1 ancillary
worker for
worker
every 30
residents or part
thereof,
between 7 a.m.
and 6 p.m.
Home/ hostel for Persons with Disabilities
HWH for Ex-MI
(Note)
Supported Hostel
for Semiindependent
Living
HSMH/ HSPH
(Note)
HMMH
(Note)
1 home manager
1 home manager
1 home manager
1 hostel manager
1 ancillary
worker for every
30 residents or
part thereof,
between 7a.m.
and 6 p.m.
1 ancillary
worker for every
60 residents or
part thereof,
between 7a.m.
and 6 p.m.
(a) 1 ancillary
worker for every 25
residents or part
thereof, between
7a.m. and 10 a.m.
and from 4 p.m. to
10 p.m.
(a) 1 ancillary/ care
worker for every
30 residents or part
thereof, between 7
a.m. and 10 a.m.
and from 4 p.m. to
10 p.m.
(b) *1 ancillary
worker for every 50
residents or part
thereof, between 10
a.m. and 4 p.m.
30
(b) *1 ancillary/
care worker for
every 60 residents
or part thereof,
between 10 a.m.
and 4 p.m.
Type of Residential Care Home for Persons with Disabilities
Type of
Staff
Care
worker
Care and
Attention
Home for the
Severely
Disabled
(Note)
(a) 1 care
worker for
every 15
residents or part
thereof,
between 7 a.m.
and 3 p.m.
(b) 1 care
worker for
every 20
residents or part
thereof,
between 3 p.m.
and 10 p.m.
(c) 1 care
worker for
every 30
residents or part
thereof,
between 10
p.m. and 7a.m.
Home/ hostel for Persons with Disabilities
HSMH/ HSPH
(Note)
HMMH
(Note)
(a) 1 care/
ancillary worker
for every 20
residents or part
thereof, between
7 a.m. and 10
a.m. and between
4 p.m. and 10
p.m.
(a) 1 care/
ancillary worker
for every 30
residents or part
thereof, between
7 a.m. and 10
a.m. and between
4 p.m. and 10
p.m.
(b) *1 care/
ancillary worker
for every 60
residents or part
thereof, between
10 a.m. and 4
p.m.
(b) *1 care/
ancillary worker
for every 60
residents or part
thereof, between
10 a.m. and 4
p.m.
*not applicable if
over 20 residents
stay in the hostel
throughout the
day, in which
case, (a) will
apply.
*not applicable if
over 30 residents
stay in the hostel
throughout the
day, in which
case (a) will
apply.
(c) 1 ancillary/
care worker for
every 30
residents or part
thereof, between
10 p.m. and
7a.m.
(c) 1 ancillary/
care worker for
every 60
residents or part
thereof, between
10 p.m. and
7a.m.
31
HWH for Ex-MI
(Note)
Supported Hostel
for Semiindependent
Living
*not applicable if
over 25 residents
stay in the hostel
throughout the day,
in which case (a)
will apply.
*not applicable if
over 30 residents
stay in the hostel
throughout the day,
in which case (a)
will apply.
(c) 1 ancillary
worker for every 60
residents or part
thereof, between 10
p.m. and 7 a.m.
(c) 1 ancillary/ care
worker for every
60 residents or part
thereof, between
10 p.m. and 7 a.m.
Type of Residential Care Home for Persons with Disabilities
Type of
Staff
Nurse
Care and
Attention
Home for the
Severely
Disabled
(Note)
(a) Unless a
health worker is
present, 1 nurse
for every 60
residents or part
thereof,
between 7 a.m.
and 6 p.m.
(b) Unless a
health worker is
present, 1 nurse
between 6 p.m.
and 7 a.m.
Health
worker
(a) Unless a
nurse is present,
1 health worker
for every 30
residents or part
thereof,
between 7 a.m.
and 6 p.m.
(b) Unless a
nurse is present,
one health
worker for
every 100
residents or part
thereof,
between 6 p.m.
and 7 a.m.
Home/ hostel for Persons with Disabilities
HSMH/ HSPH
(Note)
HMMH
(Note)
(a) Unless a
No nurse
health worker is required.
present, 1 nurse
for every 60
residents or part
thereof, between
7 a.m. and 6 p.m.
HWH for Ex-MI
(Note)
Supported Hostel
for Semiindependent
Living
At least 1 nurse,
unless there is a
health worker on
the establishment
for every 30
residents or part
thereof.
No nurse required.
Unless there is a
nurse on the
establishment, 1
health worker for
every 30 residents
or part thereof.
No health worker
required.
(b) Unless a
health worker is
present, 1 nurse
between 6 p.m.
and 7 a.m.
(a) Unless a
No health worker
nurse is present, required.
1 health worker
for every 30
residents or part
thereof, between
7 a.m. and 6 p.m.
(b) Unless a
nurse is present,
one health
worker for every
100 residents or
part thereof,
between 6 p.m.
and 7 a.m.
Note: At least one registered social worker should be included in the staffing provision.
A social worker means any person whose name appears on the register of social
workers kept under the Social Workers Registration Ordinance (Cap. 505). The
social worker is responsible for rendering professional input through a course of
well-structured and goal-oriented activities geared towards the well-being and
training needs of residents.
32
7.2 Duties and responsibilities
7.2.1
The Operator
An operator means a person who runs the residential care home for persons
with disabilities.
The duties of an operator include -
(a)
employment of staff;
(b)
maintenance of records of staff;
(c)
furnishing of plans or diagrams of the premises; and
(d)
furnishing of details of fee charging.
As a matter of good practice, an operator should inform the residents in
writing of any proposed increase in fees and charges for any service or
commodity at least 30 days in advance of the effective date of implementation.
7.2.2
The Home Manager
A home manager means any person responsible for the management of a
residential care home for persons with disabilities.
A home manager is
responsible for (a)
overall administration and staffing matters of the home;
(b)
planning, organizing and implementation of social programmes and
caring schedules to meet the needs of the residents of the home;
(c)
maintaining an acceptable standard of cleanliness, tidiness and
sanitation;
(d)
dealing with all emergency situations;
(e)
maintenance of up-to-date records of the home;
(f)
reporting infectious disease in accordance with the Prevention of the
Spread of Infectious Diseases Regulations, Cap. 141, sub. leg. B; and
(g)
providing information concerning the home as required by the Director
33
of Social Welfare.
7.2.3
The Registered Social Worker
A social worker means any person whose name appears on the register of
social workers kept under the Social Workers Registration Ordinance (Cap.
505).
The social worker is responsible for rendering professional input
through a course of well-structured and goal-oriented activities geared towards
the well-being and training needs of residents.
7.2.4
The Nurse
A nurse means any person whose name appears either on the register of nurses
maintained under Section 5 of the Nurses Registration Ordinance, Cap. 164, or
the roll of enrolled nurses maintained under Section 11 of that Ordinance.
7.2.5
The Health Worker
A health worker means any person whose name appears on the register
maintained by the Director of Social Welfare under Section 5 of the
Residential Care Homes (Elderly Persons) Regulation.
For more information
on details of the health worker, please refer to the Code of Practice for
Residential Care Homes (Elderly Persons).
7.2.6
The Care Worker
A care worker means any person other than an ancillary worker, health worker
or nurse responsible for rendering daily and personal care to the residents.
A
care worker shall follow the personal care schedule designed by a nurse or
health worker and provide daily personal care services to the residents.
34
7.2.7
Ancillary Worker
An ancillary worker means any person, other than a care worker, health
worker or nurse, employed by an operator.
Ancillary workers can refer to a
cook, domestic servant, driver, gardener, watchman, welfare worker or clerk,
and is responsible for carrying out duties relating to the daily care and training
of the residents and clerical support to the home.
7.3
Overnight Staff
At least two staff should be on duty between 10 p.m. and 7 a.m. for a
care-and-attention home for the severely disabled and for a home for the severely
physically/ mentally handicapped.
For other types of homes, there should at least be
one staff available on site to provide assistance if required and one staff on call in
case of emergency.
7.4
Conditions of Service
7.4.1
Medical Examination
All staff of a residential care home for persons with disabilities should receive
a pre-employment medical examination conducted by a registered medical
practitioner to certify that the staff is able to perform the inherent requirements
and duties of the job.
Operators of RCHDs should consider the provision of
reasonable accommodation to job applicants who are found to have disabilities
in order to accommodate them to carry out the inherent requirement of the job
unless the provision of such accommodation would impose an unjustifiable
hardship on the employers.
7.4.2
Salary
Salary should commensurate with qualifications and job responsibilities.
salary package offering incentives is desirable.
35
A
The package will be
reviewed regularly, if necessary, to meet changes in the cost of living.
7.4.3
Hours of Work
For all types of residential care homes for persons with disabilities, there
should be a minimum of two shifts of workers serving in the home.
The
number of working hours is usually agreed upon in the contract of
employment between the employer and the employee.
7.4.4
Sick Leave
The maximum number of days of paid sick leave should be in line with what
is allowed under Part VII of the Employment Ordinance, Cap. 57.
7.4.5
Maternity Leave
A female employee covered by the Employment Ordinance, Cap. 57 should be
paid, whilst on maternity leave, at a rate as specified in the Employment
Ordinance, Cap. 57.
7.4.6
Annual Leave
All staff members are normally expected to be given at least the minimum
amount of annual leave at a rate as specified in the Employment Ordinance,
Cap. 57.
7.4.7
Termination of Service
Subject to the Employment Ordinance, Cap. 57 and the terms of the relevant
contract, either party to a contract of employment may at any time after the
probationary period terminate the contract by giving the other party
one-month notice, orally or in writing, of his intention to do so.
Employment Ordinance, Cap. 57, is relevant.
36
Part II of the
7.4.8
Insurance
All staff should be covered by the employees’ compensation insurance.
7.4.9
Retirement Protection
The Mandatory Provident Fund (MPF) is a retirement protection system
established under the Mandatory Provident Fund Schemes Ordinance.
All
staff aged between 18 and 65 must participate as members of a registered MPF
scheme or other existing approved retirement schemes.
Employers and
employees should each contribute 5% of the salary of the staff in accordance
with the requirements of the Ordinance.
7.4.10 Others
Personnel policy should comply with the conditions and requirements set in
the Employment Ordinance, Cap. 57, and further enquiries on the matter
related to personnel or employment can be made to the Labour Relations
Service of the Labour Department.
7.5 First Aid Training
7.5.1
All staff should have a basic knowledge of first aid and at least one employee
in a residential care home for persons with disabilities should have completed
a course in first aid and holds a valid first aid certificate.
The First Aid
Course run by the Hong Kong St. John Ambulance Association, the Hong
Kong Red Cross and the Auxiliary Medical Service are courses recognized by
the Director of Social Welfare.
7.5.2
Registered nurses and enrolled nurses within the meaning of the Nurses
Registration Ordinance (Cap. 164) are recognized for their first aid knowledge
and skills.
Paragraph 7.5.1 does not apply to residential care homes that have
employed either a registered nurse or an enrolled nurse.
37
7.6
Relief Staff
Relief staff should be arranged if there is staff on casual, vacation or sick leave so as
to ensure that a residential care home for persons with disabilities can at any time
meet the minimum staffing requirements.
7.7
Importation of Labour
The operator and home manager should observe the terms and conditions of
employment for staff imported under the Supplementary Labour Scheme.
terms and conditions are stipulated in the employment contract.
Such
The operator may
be legally responsible for any violation of the immigration and labour rules and
regulations in relation to imported staff.
38
CHAPTER 8
FURNITURE AND EQUIPMENT
8.1
General
8.1.1
It is important that a residential care home for persons with disabilities should
have furniture and equipment specially made for the use of the disabled
residents.
8.1.2
There should be the provision of at least one first aid box on each floor, or in
each separate unit of the home if the home premises is located at different and
non-adjoining unit(s) of the same floor.
The first aid box should include at
least bandages, elastoplasts, dressings, mild antiseptic (e.g. 1% solution of
savlon, 0.3% solution of Hibitane), ointment suitable for burns and scalds (e.g.
silver sulphadiazine), ointment suitable for stings and bites (e.g. antisan cream)
etc.
8.1.3
This Chapter listed out furniture and equipment recommended for use in a
residential care home for persons with disabilities.
Every home should,
according to its own circumstances, procure appropriate furniture and
equipment, to ensure provision of proper care to the residents.
8.1.4
All furniture and equipment should be properly maintained, replaced and
renovated.
8.2
Dormitory
Items
Minimum Quantity Recommended
(1) Single bed (Note)
1 no. for each resident (double-bunk beds
may be used for disabled persons with no
mobility problems for more economical
use of space)
(2) Bedside cupboard for personal
belongings
1 no. for each resident
(3) Wardrobe
1 no. for each resident
(4) Chair (with back)
1 no. for each resident
39
Items
Minimum Quantity Recommended
(5) Heater
1 no. for each dormitory
(6) Mattress
1 sheet for each resident
(7) Mattress cover
1 no. for each resident
(8) Pillow
1 no. for each resident
(9) Pillow case
(10) Bed cover
2 nos. for each resident plus appropriate
number for spare use
1 no. for each resident
(11) Bed sheet
2 nos. for each resident
(12) Blanket
1 no. for each resident plus appropriate
number for spare use
1 no. for each resident plus appropriate
number for spare use
(13) Blanket cover
(14) Quilt
1 no. for each resident plus appropriate
number for spare use
1 no. for each resident plus appropriate
number for spare use
(15) Quilt cover
(16) Rubber sheet
depends on need
(17) Litter bin
1 no. for each dormitory
(18) Electric clock
1 no. for each dormitory
(19) Vacuum flask
optional
(20) Thermos bag
optional
(21) curtain with rail
1 set for each window opening
(22) Towel rack
optional
(23) Electric fan and/ or air
conditioner
be able to provide sufficient ventilation
(24) Call bell
(25) Name Plate
1 no. for each dormitory for
care-and-attention residents (optional for
homes serving persons with less severe
disabilities)
1 no. for each dormitory
(26) Screen
depends on need
(27) Emergency light
1 no. for each dormitory
(28) Drinking pot
optional
(29) Insect trap light
depends on need
Note: It is desirable that adjustable hospital beds (two-crane) are provided for needy
care-and-attention residents.
40
8.3
Sitting/ Dining Room
Items
Minimum Quantity Recommended
(1) Dining table and chair
depends on the number of residents
(2) Sofa
1 set
(3) Colour television set and other
audio-visual equipment
1 set
(4) Supplies of newspaper, magazine
and books
(5) Electric clock and calendar
1 no. of daily newspaper each day and 1
no. of weekly magazine each week
1 set
(6) Notice board
1 no.
(7) Stackable chair
depends on the number of residents
(8) Litter bin
1 no.
(9) Curtain with rail
1 set for each window opening
(10) Vacuum flask/ tea urn
1 no.
(11) Telephone
1 set, depends on the number of residents
(12) Cupboard
optional
(13) Green plant in pot
optional
(14) Picture with frame
optional
(15) Recreational or physical training
equipment
depends on number of residents
(16) Food trolley
optional
(17) Serving trays
optional
(18) Water dispenser
optional
(19) Newspaper and magazine rack
1 no.
(20) Special feeding equipment such as depends on need for spastic/ multipleadapted spoon and fork, bowl and handicapped residents
cup
8.4
Toilet/ Bathroom (Note 1)
Items
Minimum Quantity Recommended
(1) Litter bin
optional
(2) Commode
depends on the number of care-andattention residents
(3) Shower chair/ bathtub seat
depends on the number of
care-and-attention residents
41
Items
Minimum Quantity Recommended
(4) Hair dryer
1 no.
(5) Plastic bucket with lid
1 no.
(6) Urinal
depends on the number of
care-and-attention residents
depends on the number of
care-and-attention residents
depends on need
(7) Bed pan
(8) Sterilizer for bed pan and/ or bed
pan washer
(9) Heater for hot water supply
(Note 2)
(10) Adult size European flush toilet/
water basin/ shower point/ bath
1 no.
at a ratio in accordance with Building
(Standards of Sanitary Fitments,
Plumbing, Drainage Works and Latrines)
Regulations, Cap. 123, sub. leg. I.
(11) Individual towel, comb, mug and
tooth brush
1 set for each resident
(12) Heater
depends on need
(13) Exhaust fan
1 no. in each toilet or bathroom
Note: 1.
2.
Items such as mirrors should be provided if not included in the fitting-out
work.
If gas water heater is used, the heater shall be of a room sealed type.
8.5 Kitchen/ Pantry
Items
Minimum Quantity Recommended
(1) Cooking utensils
sum
(2) Dining utensils
depends on the number of residents
(3) Refrigerator/ freezer
1 no., size depends on the number of
residents
(4) Hot water supply for washing
utensils
depends on need
(5) Meat mincer
1 no.
(6) Food blender
1 no.
(7) Rice cooker
1 no., size depends on the number of
residents
(8) Microwave oven
1 no.
(9) Hot water boiler
1 no., size depends on the number of
residents
(10) Cleaning utensils
depends on need
42
Items
Minimum Quantity Recommended
(11) Food container
depends on need
(12) Plastic tray
depends on need
(13) Plastic basket
depends on need
(14) Garbage bin with lid
1 no.
(15) Notice board/ white board
1 no.
(16) Exhaust fan
1 no.
Note: Use of town gas or electricity for cooking in kitchen is preferred. Kerosene
is not allowed to be used for safety reasons. If liquefied petroleum gas is
used, the gas should be piped from a central supply or from cylinders stored in
a purposely-designed chamber constructed in accordance with the provisions
of the Gas Safety Ordinance, Cap. 51 and its subsidiary Regulations. All gas
cooking equipment should be fitted with flame failure device wherever
possible.
8.6
8.7
Laundry
Items
(1) Washing machine
Minimum Quantity Recommended
1 no., depends on the number of residents
(2) Drying machine
1 no., depends on the number of residents
(3) Iron
1 no.
(4) Ironing board
1 no.
(5) Baskets for clothing
2 nos.
(6) Plastic bucket
2 nos.
(7) Storage rack
optional
Office
Items
Minimum Quantity Recommended
(1) Office desk
1 no.
(2) Office chair
2 nos.
(3) Filing cabinet
1 no.
(4) Key box
1 no.
(5) First aid box with supply
1 no.
(6) Stationery
optional
43
Items
8.8
Minimum Quantity Recommended
(7) Telephone
1 set
(8) Notice board/ white board
1 no.
Medical Equipment and Supplies
Items
Minimum Quantity Recommended
(1) Disinfecting equipment and
disinfecting/ dressing supplies
including forceps (various), scissors,
kidney dish, dressing trays, dressing
bowls or sterile packs
(2) Disinfectant and dressings
should be provided in
care-and-attention homes and homes
for the severely mentally, physically
or multiple handicapped persons.
(3) Sphygmomanometer (electronic
model preferred)
(4) Stethoscope
1 no.
- ditto -
1 no.
(5) Thermometer (electronic model
preferred)
(6) Thermometer container
at least 2 no. for each home
depends on need
(7) Diagnostic set
depends on need
(8) Tongue depressor (disposable)
sum
(9) Torches
depends on need
(10) * Nasogastric Tube
depends on need
(11) Urinary bag/ *Foley catheter
depends on need #
(12) Portable oxygen respirator
depends on need
(13) Suction pump (aspirator)
depends on need
(14) Medicine cup
depends on need
(15) Gloves (disposable)
depends on need
(16) Urine testing stix
depends on need
(17) Bandages (various)
(18) Scale (preferably chair-type)
should be provided in all types of
homes
depends on need
(19) Walking aids/ wheelchairs/
commode chairs
(20) Ripple bed mattress
(21) Lotion
depends on the no. of
care-and-attention residents #
depends on need
depends on need #
(22) Adult diaper
sum #
44
Items
Minimum Quantity Recommended
(23) Drugging trolley
1 no.
Note: Equipment marked with * should be applied by a nurse only.
Equipment/ supplies marked with # are personal items to be provided by
residents, however, operators should keep adequate stock for contingency use.
8.9
Miscellaneous
Items
Minimum Quantity Recommended
(1) Vacuum cleaner
1 no.
(2) Storage facilities
(3) Cleaning equipment
adequate storage facilities should be
provided to ensure that personal
belongings of residents and general stores
of the home are tidily kept
sum
(4) Cleansing material
sum
45
CHAPTER 9
HEALTH AND CARE SERVICES
9.1
General
The purpose of providing nursing and personal care to persons with disabilities is to
prevent rapid health deterioration, to enhance activities for daily living, to maintain
health and to meet the individual nursing and personal care needs of the disabled
residents.
The home manager should ensure that nursing and personal care to the
residents are properly and adequately rendered by responsible and qualified staff and
where necessary, appropriate referrals to health professionals be made.
9.2
Health
Regular medical examinations may not be warranted for the majority of residents.
However, such examinations may be required for individual residents at regular
intervals depending on needs.
To provide care of good quality in the residential care
homes for persons with disabilities, personal, food and environmental hygiene as well
as proper diet, regular exercise and home safety should be promoted.
The following
principles should be observed (a)
An updated health record for each resident should be kept by the home to
facilitate his or her care.
The record should contain information pertaining to
the health and care of the resident, including medical history, medication
record, special diet, family support and matters of concern related to nursing
care;
(b)
If a resident falls ill, the home should inform his parent/ next-of-kin/
guardian (if applicable) and arrange early medical treatment for the resident.
The home should take the sick resident to the nearby Accident and
Emergency Department in case of emergency;
46
(c)
Health inspection, medical consultation or follow-up treatment should be
made at regular intervals and when necessary.
Staff of the residential care
homes should receive regular training on common health problems and those
specific to disabled persons to enable early recognition in order to provide best
care for their clients and for the sake of protection of staff and other residents;
(d)
In the event of any staff or resident suffering or suspected to be suffering from
an infectious disease, the home manager should ensure that the case is
reported in accordance with the Prevention of the Spread of Infectious
Diseases Regulations, Cap. 141, sub. leg. B.
For this purpose, the case may
be brought to the attention of a medical practitioner or a medical officer of the
Department of Health or the Hospital Authority.
Infectious diseases as set
out in the First Schedule to the Quarantine and Prevention of Disease
Ordinance, Cap. 141 include Acute poliomyelitis, Amoebic dysentery,
Bacillary dysentery, Cholera, Dengue fever, Diphtheria, Food poisoning,
Legionnaires’ disease, Leprosy, Malaria, Measles, Meningococcal infections,
Mumps, Paratyphoid fever, Plague, Rabies, Relapsing fever, Rubella, Scarlet
fever, Tetanus, Tuberculosis, Typhoid fever, Typhus, Viral hepatitis,
Whooping cough, Chickenpox and Yellow fever;
(e)
Besides infectious diseases, in the event of an outbreak or suspected outbreak
of a communicable disease e.g. influenza, scabies, among staff or residents,
which by the nature of communal living in the residential care home for
persons with disabilities warrants special attention of the Department of
Health, the home manager should promptly report the case to the respective
regional offices of the Department of Health for information and advice;
(f)
For preventing spread of communicable diseases, reference should be made to
the Guidelines on Prevention of Communicable Diseases in Residential Care
Homes for the Elderly and People with Disabilities issued by the Department
of Health, as follows -
47
(i)
Diseases spread by airborne or direct contact transmission (Example:
influenza, tuberculosis, upper respiratory tract infection, head lice and
scabies)z
maintain good indoor ventilation;
z
keep hands clean and wash hands properly;
z
cleanse used furniture properly;
z
dispose of used tissue paper properly;
z
cover nose and mouth when sneezing or coughing;
z
wash hands when they are dirtied by respiratory secretions e.g.
after sneezing;
z
prevent head lice by keeping hair clean;
z
prevent scabies by regular bathing;
z
keep personal cleanliness;
z
wash hands properly after handling each resident, e.g. after
applying medication or changing diaper;
(ii)
z
wash linen of residents infected with scabies separately;
z
do not share towels.
Foodborne diseases (Example: food poisoning, bacillary dysentery,
hepatitis A, Norwalk-like virus infection)z
observe good personal, food and environmental hygiene;
z
store food properly and avoid cross contamination between raw
and cooked food;
z
cook food thoroughly;
z
wash hands properly before preparing food or eating;
z
flush toilet after use and wash hands properly;
z
clean cooking and eating utensils properly;
z
keep kitchen clean, tidy and dry;
z
wash hands properly before feeding each resident and after
changing diaper for each resident.
(iii)
Blood-borne diseases (Example: hepatitis B, human immunodeficiency
virus (HIV) infection and Acquired Immunodeficiency Syndrome
48
(AIDS) influenza)z
wear gloves when handling wounds, nose bleeding and soiled
articles; wash hands afterwards;
z
wipe surfaces contaminated with blood with disposable towels
soaked in diluted household bleach 1:49 and rinse with water 30
minutes later;
(iv)
z
never share toothbrushes/ shavers;
z
take care in handling of shavers/ syringes/ needles.
Vector-borne diseases (Example: malaria, dengue fever and typhus
fever)z
keep the premises clean, tidy and rodent free;
z
put garbage in strong garbage bins with lids on at all times and
empty the contents at least once a day;
z
empty water accumulated in dishes of flowerpots and change
water in vases at least weekly to avoid breeding of mosquitoes.
(v)
Management of sick residentsIf a resident falls ill,
z
inform parent/ next-of-kin/ guardian and arrange early medical
treatment for the resident;
z
isolate the sick resident with communicable diseases if necessary;
z
take the sick resident to the nearby Accident and Emergency
Department in case of emergency;
z
ensure practice of good personal hygiene among residents (e.g.
wash the hands after toileting);
z
ensure staff wash hands before and after caring the sick residents;
z
restrict sick staff from caring the residents and advise the staff to
seek medical advice so as to minimize the spread of infection.
(g)
Medicine should be kept in a safe and locked place, and administered
properly by a nurse where available. The home manager should ensure that
all staff involved in supervising the taking of medicines have been
49
appropriately and adequately trained.
This should form part of the
induction-training programme if appropriate.
Nurses and any staff of the
home must follow the prescriptions and advice of registered medical
practitioners, and should assist to ensure that the right residents receive the
correct medicine in the correct dose at the right time and through the correct
route.
Staff should not dispense any medicine to residents on their own
opinion and/ or diagnosis and over-the-counter medication should be avoided;
(h)
All medicines given must be accurately recorded.
As a minimum this should
indicate the client’s name, the name, dosage and route of medicine given, the
date and time given and the signature of the person who has assisted.
omissions must be recorded with the reason for omission.
special drugs should also be kept.
Any
Record of use of
Special drugs include all drugs that
warrant special attention in the intake e.g. injections, drugs prescribed to be
taken whenever necessary, etc.; and
(i)
To maintain optimal physical function, active exercise programmes should be
provided to all residents, especially the severely physically disabled residents.
9.3
Personal Care
Personal care schedule must be designed so that personal care services such as
bathing, hair washing, hair cutting, shaving, nail cutting, changing of bed sheets and
pillow cases, changing of clothes etc. will be provided or arranged within reasonable
time intervals.
9.4
General Principles in Application of Physical Restraint
9.4.1
Physical restraint refers to the use of purpose-made devices to limit a
resident’s movement to minimize harm to himself/ herself and/ or other
residents.
Physical restraints may include cloth vests, soft ties, soft cloth
mittens, seat belts etc.
It also includes the use of detachable tray/ table on
50
commodes/ geriatric chairs to confine a person to a place other than its
original purpose.
Before purchasing or using physical restraints, medical
advice and where necessary, written professional advice of clinical
psychologists, should be sought to ensure that only properly tested devices are
used and used correctly in compliance with safety standards.
The use of
bandages for physical restraint is explicitly forbidden.
9.4.2
Having regard to the human rights and personal dignity of disabled residents,
the use of physical restraints is generally discouraged.
However, the homes
may consider it necessary to apply restraints to limit the resident’s movement
for the following reasons (a)
to prevent the resident from injuring himself/ herself or others;
(b)
to prevent the resident from falling; and/ or
(c)
to prevent the resident from removing urinary bags, Foley
catheters, feeding tubes, napkins or clothes.
9.4.3
In using the physical restraints, the welfare, dignity and comfort of the
resident should always be taken into consideration.
Restraints should only be
considered as the last resort, not the first choice and as the exception, not the
rule and be applied only when the well being of the resident and/ or other
residents is in jeopardy.
9.5
Principles to be Observed in Applying Physical Restraint
Restraints should only be applied by the home manager or nurse-in-charge upon
consultation with a registered medical practitioner (written professional advice of
clinical psychologists should also be sought, where necessary), parent/ next-of-kin/
guardian and the resident himself/ herself if he/ she has normal intellectual
functioning.
If a home considers the use of physical restraint necessary, proper
guidelines should be developed on the application of restraint.
51
All the staff members
should receive proper training, especially in deciding when to use physical restraint,
the issues regarding human dignity and respect, technical skills in applying physical
restraint and the caring procedures entailed after the application of the restraint.
The
following principles should be observed (a)
Consent from the residents or their parents/ next-of-kin/ guardians must be
sought in relation to any application of physical restraints;
(b)
Explanation should be given to the parent/ next-of-kin/ guardian and the
resident, when application of restraint becomes necessary;
(c)
No restraints with locking devices should be used;
(d)
Physical restraint should not be used without instituting procedures to
reinforce more adaptable behaviour at the same time or when implementation
of less restrictive procedures have not been tried;
(e)
Restraints should be used for the minimum of time and should not be applied
longer than necessary;
(f)
Restraints must be used with care to avoid accidental harm to the resident;
(g)
The need for continuing the application of restraints should be evaluated
regularly;
(h)
Restraints should be of the right size and in good condition so as to ensure the
least possible discomfort;
(i)
Restraints should be worn and secured properly to ensure safety and comfort
with allowance for change of position;
(j)
Restraints must be released at least at 2-hour intervals for 15 minutes to allow
movement and exercise at daytime. At bedtime, turning of sleeping position
52
at 2-hour intervals must be carried out and documented to avoid the
development of bed sore;
(k)
Restraints should be applied in such a manner so that quick removal in case of
fire and other emergency can be achieved;
(l)
During the period of application, the resident must be under close observation
and measures should be taken to prevent displacement of restraint, impairment
of blood circulation and respiratory difficulty.
The condition of the resident
while under restraint should be reviewed at least once every 2 hours by the
home manager/ nurse/ health worker to determine if continuous use of
restraint is warranted.
The time frame required for review depends on the
specific situation of each resident;
(m)
Physically-restrained residents must not be kept alone in a room;
(n)
The type of restraints used should not cause abrasions or physical injury;
(o)
Restraints should never be used as punishment, as a substitute for caring of the
residents or for the convenience of staff; and
(p)
Records on the use of restraint as advised in Chapter 3 of this Code of Practice
must be made and the incident should be reported to the parent/ next-of-kin/
guardian.
9.6 Notes to be Observed in Using Clinical and Para-medical Equipment
9.6.1
Use of Foley Catheter
(a)
Foley catheter should only be used for treatment purpose or when warranted in
the circumstances of the residents’ medical condition and are endorsed as
necessary by a registered medical practitioner;
53
(b)
Insertion of Foley catheter should be done by a nurse and should be changed
weekly;
(c)
The Foley catheter should be placed in a position to allow urine to flow freely
and not be infected. The urinary bag should be placed at a position below
supra-pubic level to prevent reflux of urine;
(d)
Should monitor and keep record of intake and output of fluid and observe if
there is any abnormality.
If deemed necessary, medical opinion should be
sought immediately; and
(e)
The use of Foley catheter should be reviewed regularly by a registered medical
practitioner or nurse to see if the use should be continued.
9.6.2
Use of Nasogastric Tube
(a)
Nasogastric tube should only be used for treatment purpose or when warranted
in the circumstances of the residents’ medical condition and endorsed as
necessary by a registered medical practitioner;
(b)
Insertion of nasogastric tube should be done by a nurse and should be changed
regularly;
(c)
Before every feeding, should ensure that the nasogastric tube is properly
positioned.
Feeding by pressure is not allowed.
Mouth and nasal care
should be noted;
(d)
Intervals of feeding should be scheduled according to need or as advised by a
registered medical practitioner/ dietitian. Generally, feeding should be
scheduled at the interval of 3 to 4 hours;
(e)
Should monitor and keep record of intake and output of fluid for residents on
nasogastric feeding and observe if there is any abnormality.
54
If deemed
necessary, medical opinion should be sought immediately; and
(f)
The use of nasogastric tube should be reviewed regularly by a registered
medical practitioner or nurse to see if the use should be continued.
55
CHAPTER 10
NUTRITION AND DIET
10.1
General
An adequate and nutritionally well-balanced diet is essential to the good health of
persons with disabilities.
and to prevent illness.
Sufficient and nutritional diet is important to maintain life
The nature and amount of food should be provided according
to the individual need of the disabled residents and the preparation and transportation
process should be hygienic.
10.2
Design of Menu
It is essential for all residential care homes for persons with disabilities to design a
menu in advance covering a period of 2 to 4 weeks.
The menu should be varied
from time to time and be available at all times for inspection.
The menu should be
designed having regard to residents’ personal preferences and medical needs.
The
menu should be used as a general guide on the range and variety of meals produced,
although it may be subject to variations according to seasonal availability of foods.
10.3
Meals and diet
Meals provided should meet with the nutritional and caloric requirements and be
appropriate to the need of the residents, such as special diet due to medical problems
or religious belief.
A balanced diet should include an appropriate content of dairy
product, grain/ cereal, vegetables, meat and fruit in order to satisfy the minimum
physiological need of residents.
Amount of food must be sufficient in quantity.
Attention should also be given to the condition, colour, taste, texture and temperature
of food.
10.4
Preparation and Serving of Food
56
Food preparation involves the cooking process, proper storage, proper thawing of
frozen food, use of recipes and correct mixture of ingredients. Food should be
served at proper temperature.
Proper preparation also includes timely use of food
items since freshness of food can affect nutritional value, taste, texture and
appearance of food.
In preparing food, it is essential that nutrients be preserved and
food hygiene should be observed. The following points should therefore be observed (a)
Wash hand properly before preparing food and wounds on hands should be
protected with waterproof dressing to prevent passing germs from the wounds
to food;
(b)
Do not touch cooked food with bare hands and do not smoke while handling
food;
(c)
Raw food such as carrots, lettuces, tomatoes or fruits must be thoroughly
washed and rinsed in clean tap water. Meat, poultry and seafood should be
rinsed in cold and clean water;
(d)
Vegetables and meat should be washed before chopping;
(e)
Vegetables should be cooked in small amount of water, not be overcooked and
not be cooked with baking soda, and cooked as near mealtime as possible;
(f)
Meat should be properly grounded, or minced for easy chewing and
digestion.
(g)
Ground meat and poultry should be cooked thoroughly;
Frozen meat or fish must be thawed completely before cooking and food taken
out from the refrigerator should be reheated thoroughly before consumption;
(h)
Copper utensils, which may cause chemical changes to the nutrients, should
not be used;
(i)
To prevent food poisoning, food must be carefully and hygienically stored and
prepared.
Discard the outer leaves of leafy vegetables and immerse the
vegetables in water for one hour before washing to eliminate possible pesticide
residues.
All kinds of foodstuff, whether raw or cooked, should be properly
covered, stored and put under refrigeration.
Refrigerators should be properly
maintained to ensure their temperature is below 4°C and freezers at or below
-18°C at all times and overloading should be avoided to allow proper
circulation of cold air.
Defrosted food should not be refrozen; and
57
(j)
Avoid using the same knife to slice meat and chop vegetables unless it has
been cleaned in between.
To avoid cross-contamination, cutting boards
should be sanitized after each use and separate utensils for cooked food and
raw food should be used.
10.5
Meal Time
10.5.1 There should be at least 3 meals (breakfast, lunch and dinner) each day except
for homes for the disabled/ hostels for semi-independent living where the
residents may attend work/ day programmes elsewhere during mid-day.
The
timing of every meal should be spaced at appropriate intervals and served
properly e.g. cooked food be eaten immediately, hot food be served hot and
cold food be served cold.
Effort should be made to identify those residents
with difficulty in swallowing and to render proper care in feeding them.
The
eating abilities and behaviour of residents with swallowing difficulties/
problems and the types of food served should be reviewed two weeks after
admission and periodically thereafter on a regular basis.
Close supervision at
meal time is necessary for all residents, even those classified to be able to feed
themselves.
Assistance should be given to feed those residents who cannot
eat by themselves.
10.5.2 For care-and-attention homes for persons with severe/ multiple disabilities, a
health worker or a nurse should be present each time a meal is served to
residents.
10.6
Special Attention on Food Provision
Special attention should be paid to the following in food provision (a)
To prevent choking - food must be fed at reasonable pace for residents who
cannot eat by themselves.
In case of eating a new type of food, especially
solid and/ or sticky food, the food should be delivered in small quantity one at
a time to avoid choking as well as to facilitate eating.
58
Where applicable, the
food should be appropriately prepared, e.g. having it soaked in a drink to make
it easy to swallow;
(b)
To prevent constipation - sufficient amount of fluid including water, soup,
juice and high-fibre food such as vegetables and fruits should be given to
residents. Use of laxative must be applied only with the direction of a
registered medical practitioner.
10.7
Provision of Water
Water for drinking, cooking and washing must be provided from the mains or any
other approved source.
10.8
Other Information
In case of need for more guidance, information leaflets and pamphlets can be obtained
from government departments concerned.
59
CHAPTER 11
CLEANLINESS AND SANITATION
11.1
General
A high standard of cleanliness and sanitation in a residential care home for persons
with disabilities should be maintained at all times.
This helps in preventing diseases
and provides a comfortable and satisfactory living environment to the residents.
11.2
Staff
Personal hygiene should be observed by all staff in a residential care home for
persons with disabilities, particularly those who handle food and render daily personal
care to the residents.
(a)
The following points should be observed -
Any person suffering from a discharging wound, diarrhoea, vomiting or a
communicable disease should stop from handling food;
(b)
Clothes should always be clean;
(c)
Finger nails should be clean and manicured regularly;
(d)
Hair should be clean and tidily combed.
Long hair should be properly tied
up when preparing food and providing personal care to residents; and
(e)
Hands should always be washed with soap and water after using the toilet,
before preparing food and after providing personal care to the residents and
handling of vomitus, faeces and napkins.
11.3
Residents
60
The following points should be observed (a)
Personal hygiene of the resident;
(b)
Clothes should always be clean;
(c)
Provision of individual basic toiletry items should be ensured for each
resident;
(d)
Tidiness in storage at a reasonable level and personal belongings should be
allowed; and
(e)
11.4
Provision of sufficient storage facilities.
Cleaning Schedule
A thorough cleaning schedule should be set up.
The following are some of the main
points (a)
All floors should be cleaned daily.
toilet and kitchen floors.
Special attention should be given to bath,
Walls, doors, windows, ceilings and other
structures should also be kept clean at all times;
(b)
The kitchen, cooking utensils and food utensils should be properly washed,
cleaned, sterilized and stored immediately after each preparation of food.
The utensils should be in proper repair and free from cracks;
(c)
Refrigerators should be cleaned and defrosted regularly;
(d)
Bed sheets and pillow cases must be cleaned and changed regularly;
61
(e)
Furniture and equipment should be cleaned regularly;
(f)
All garbage receptacles must be cleaned regularly and covered at all times;
(g)
Proper cleansing and sterilization of medical facilities and equipment of the
home should be conducted regularly by nurses or health workers; and
(h)
All facilities and furniture in a residential care home for persons with
disabilities should be cleaned regularly.
11.5
General Sanitation
(a)
Sewage and drainage systems must be properly installed, inspected and always
in working order;
11.6
(b)
The toilet/ bathroom should be properly ventilated; and
(c)
Measures should be taken for proper pest control.
Other Information
In case of need for more guidance, information leaflets and pamphlets can be obtained
from government departments concerned.
62
CHAPTER 12
SOCIAL CARE
12.1
General
Attention to the social aspects of care is important to enhance the quality of life of
persons residing in homes.
The social climate in residential facilities is closely
linked to the quality of care and residents’ health and well-being.
Supportive
interpersonal relationships and meaningful individualised activities and social
interactions inside and outside the home will reduce isolation and enhance mental and
physical well-being.
Homogenous environment and the commitment of family
members to continue interacting with their disabled relatives provide considerable
potential for improving the social lives of residents.
12.2
Home-like Atmosphere and Adjustment to Home Life
Home managers of the residential care homes for persons with disabilities should try
to make the home less institutionalized so as to cultivate a homely feeling.
If
possible, residents should be given opportunities to get involved in their homes’
daily operation, such as dusting, cleaning, shopping, cooking or ironing.
They
should also promote interpersonal relationship and mutual trust among residents and
protect individual privacy.
To help home staff understand the needs of new residents, their abilities and habits,
etc., upon their admission, a family member, relative or friend should be required to
stay with the newly admitted resident for at least half a day.
New residents should
be helped to adjust to the residential care home environment and the complexities of
group living.
Home managers should demonstrate an understanding of residents’
anxiety and distress and enable them to live harmoniously, with opportunities to
develop their potential through the provision of a caring and stimulating
environment.
12.3
Social Interaction
63
Interaction with other people is another domain in building up the social
environment in the home.
enjoy their company.
It is good for residents to mix with one another and to
Normal socializing and interaction with families and friends
should be encouraged through home leave and visits.
Persons with disabilities have sexual needs similar to their counterparts with normal
health and/ or intelligence.
Guidance and advice should be provided to assist
residents in handling their personal hygiene and sexual needs appropriately. The
Home management should also have protocol and guidelines on the proper handling
of residents by staff members of the opposite sex.
12.4
Programmes and Activities
Programmes and activities in this context refer to activities organized for residents,
either in groups or individually, in residential care homes for persons with
disabilities.
Provision of activities is considered as part of the social care
programmes for residents and should be sensitive to individual interest and
capabilities. Through these activities, they will develop daily living, social and
communication skills that will reduce their dependence, forestall problem behaviour
as well as meet their social and recreational needs. Activities provided in the home
may include skills training, interest groups, birthday parties and festival celebration.
Where appropriate, the information of activities should be clearly displayed on
notice boards.
Residents and their family members should be encouraged to
participate in the planning of activities.
Resources available in the community
should be enlisted to help in meeting the needs of the residents and to integrate them
into the surrounding community.
Where possible, home operators should facilitate
residents to attend day training in special schools, day activity centres for mentally
handicapped persons, training and activity centres for ex-mentally ill persons,
sheltered workshops, etc.
12.5
Contact with the Outside World
64
To prevent social isolation, residents should have outings on a regular basis. The
availability of a telephone provides an important lifeline to the outside world.
Contact between homes and their local community should be encouraged.
Examples of outings include visits to the parks, shopping, church service, visiting
relatives/ family, car-ride etc.
The home should develop operational guidelines and
procedures on safety in respect of different forms of outdoor activities taken by the
residents.
When drawing up the guidelines, points to be taken into consideration
should include manpower ratio, transport arrangement, contingency plans and other
safety measures, to ensure the smooth implementation of the activities.
It is important to promote and ensure good mental health of all residents. Support
and guidance should be available to assist them in dealing with difficult situations
and prepare them for better adjustment in the community.
65
Appendix 附錄
Specimen of
Medical Examination Form
體 格 檢 驗 報 告 書 樣 本
(Please also refer to the Medical Examination Form for ExMI) (應一併參考精神病康復者體格檢驗報告書)
Personal Data of Applicant 申請人資料
Name 姓名: (English 英文) :_____________________________________ (Chinese 中文) :_______________________
Sex/ Age/ D.O.B.性別/年齡/出生日期: _______________________________________ Tel.電話: ___________________
Major Diagnosis 診斷
Mentally Handicapped 弱智
Mid 輕度†
Moderate 中度†
Server 嚴重†
Profound 極度嚴重†
Physical Handicapped 肢體傷殘Please specify請說明: _______________________________________________________
Psychiatric Illness 精神病 Please specify請說明: __________________________________________________________
Medical History 醫療紀錄
No
否
□
Yes
是
□
Allergy to food or drug對食物或藥物過敏
□
□
Epilepsy 癲癇
□
□
Swallowing Difficulties/Easy Choking 吞嚥困難
/容易哽咽
□
□
Recent Auditory/Visual Deterioration 近期聽覺/ □
視覺退化
□
Other Significant Illness 其他重要疾病
□
□
Recent Traveling (within past 6 months) 近期旅行 □
(過去6個月)
□
Symptoms of Infectious Diseases e.g. diarrhoea,
rash, frequent cough, past chest infection, etc.傳染
病徵狀,例如腹瀉,皮疹,經常咳嗽,肺部曾受
感染等
If yes, please elaborate如是,請說明﹕
□ mild輕度(once a month每月一次)
□ moderate中度 (once a week每星期一次)
□ severe 嚴重(once a day每日一次)
Physical Examination 身體檢查
Satisfactory滿意
Fair普通
Poor差
General Condition一般情況
Normal
正常
□
Abnormal
不正常
□
Lymphatic System 淋巴系統
□
□
Dental Condition 牙齒狀況
□
□
Thyroid 甲狀腺
□
□
Chest 胸
□
□
Cardiovascular System 循環系統
□
□
Abdomen 腹
□
□
Limbs, Spine 四肢、脊柱
□
□
Possible Signs of Infectious Diseases 傳染病徵兆
□
□
Other Findings 其他發現
□
□
BP 血壓:
□
□
Skin Condition, e.g. scabies, jaundice 皮膚狀況,
例如疥瘡,黃疸
mmHg度
If abnormal, please elaborate
如屬不正常,請說明﹕
Special Examination 特別檢驗
Urine 尿液:
Glucose 血糖:
Albumin 蛋白:
Stool ova/cyst: (if not done within past 3 months)
糞便化驗(如在過去 3 個月內不曾進行):
Blood 血液:
Hb:
gm/dl.
WBC:
/cu.mm.
Plat:
HBs Ag (if not vaccinated)(如未接受防疫注射):
Liver function 肝功能:
Renal function 腎功能:
/cu.m.
Reason(s) if blood test is not done:
doctor considers not clinically indicated for the test 醫生認為無需要
若沒有進行血液檢驗,原因是:
parents/guardian refuse 家長/監護人拒絕 client is uncooperative 申請人不合作
Others 其他:
CXR (if not done within past 3 months)
X 光檢驗 (若過去三個月內沒有進行):
(If CXR may suggest TB, the case has been referred to chest clinic
若 X 光檢驗顯示可能患上肺結核,個案已轉介胸肺科診所:
Others (please specify) 其他(請說明):
□ Yes 是
□ No 否
Current Treatment (specify dosage) 現時治療 (說明服用
量):
Name(s) of Treatment Providers (e.g. clinic) 提供治療者
姓名 (例如診所名稱):
Previous Operations 過往手術
Need for Special Diet 特別膳食需要
□No 否
Dates 日期
□Yes, please specify 是,請說明:
Doctor’s Recommendations 醫生建議:
1. The applicant is fit / unfit for admission to day/residential service. 申請人適合/不適合日間/住宿服務 (No
evidence of infectious disease or significant physical condition contraindicating placement into a group environment.)
(沒有證據顯示患有傳染病或明顯的健康問題,以致不適合群體的生活環境)
2.
The applicant should be referred to the following specialist for follow up examination 申請人須轉介往以下專科接受進
一步的檢驗:
Doctor’s Signature
醫生簽署:
Name in block letter
正楷姓名:
Date 日期:
Remark
備註:
1.
Hospital/Clinic
醫院/診所名稱:
Tel.電話:
Ref. No.檔案編號:
This medical examination form is valid for 6 months from the date of issue. 此體格檢驗報告由發出日起計
六個月內有效
2.
Medical examination primarily serves the purpose of formulating individual care plan rather than
screening. Flexibility should be applied whenever necessary. 體格檢驗主要作為制訂個別照顧計劃而非
作為甄選之用,故應彈性處理。
Specimen of
Medical Examination Form for ExMI
精神病康復者體格檢驗報告書樣本
Name of applicant:____________________________(
)HKIC:_________(
) Sex/Age:______
申請人姓名
身分証號碼
性別/年齡
D.O.B.: ___/___/____ (DD/MM/YYYY) Hospital/Clinic Ref. no._____________________
出生日期
(日/月/年)
醫院/診所檔案編號
Hospital / Clinic 醫院/診所: ____________________________Ward 病房:____________
Medical History (to be completed by case medical officer) 病歷紀錄(由主診醫生填寫)
Diagnosis 診斷: _______________________________________________________________________________________
Case Nature 個案性質: Ordinary 普通 / Target 對象組別/ Sub-target 次對象組別*/Others 其他:______________________
Intelligence 智能: Normal 正常/ Borderline 邊緣/ Mild 輕度/ Moderate 中度/ Severe 嚴重*
IQ Score 智商:________________ (if available 如有)
Date of assessment 評估日期: ______________________
Premorbid Personality 發病前的性格:______________________________________________________________________
Relevant medical illness(es) or disability(s)相關的疾病或殘疾:__________________________________________________
Date of onset of mental illness 最初發病日期: ____________________
Total no. of Admissions 入院次數: _________
Reason(s) for latest hospitalization 最近入院原因: ____________________________________________________________
Dates of last three admissions 最近三次入院日期: (include the present admission 包括現時入院)
Duration 期間
Name of Hospital 醫院名稱
Diagnosis 診斷
Voluntary 自願 /
Compulsory 非自願
to 至
to 至
to 至
Symptoms at present attack 現時徵狀: ____________________________________________________________________
Anti-social behaviour 反社會行為 : _____________________________Prognosis 預計判斷: _________________________
… Problem drinking 酗酒
… Drug addiction 吸毒
Maintenance treatment 持續治療: _______________________
… Problem gambling 沈溺睹博 … Others 其他:_____________________(include medication 包括服藥) ___________
… Criminal Record 犯罪紀錄 (Details 詳情______________________) Response to treatment 對治療的反應:__________
Suicidal tendency 自殺傾向 ___________ history 紀錄:_______________________________________________________
History of violence / aggressiveness 暴力/粗暴紀錄:___________________________________________________________
N a t u r e
o f
v i o l e n t
/
a g g r e s s i v e
b e h a v i o u r
暴 力 / 粗 暴 行 為 的 性
質 : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Outcome 結果 / sentence 判刑:___________________________________________________________________________
Predisposing factors to violence 引發暴力因素的素質:_______________________________________________________
Psychological 心理/ Social 社交/ Biological 生理* (please specify 請說明)_________________________________
Free from violent / aggressive behaviour in the last _____ months / years 已有_______月/年沒有出現暴力/粗暴行為*
Is applicant a conditionally discharged case 申請人是否有條件出院? YES 是 / NO 否*
The applicant is / is not * recommended to receive the service applied for 推薦/不推薦申請人接受服務
Additional remarks 額外備註: ( supplementary sheet if required, e.g. insight into mental illness 例如對精神病的自知能力,
如有需要請用補充紙張 )
__________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Doctor’s Signature 醫生簽署 :_________________________ Name in BLOCK 正楷姓名:_________________________
Tel no.電話: ___________________ext 內線: ____________ Date 日期:_______________________________________
* please delete as appropriate 請刪去不適用者
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